Trouble changing autistic child's nappy

Hi, I am a foster carer to a 12 year old autistic child. Her autism is quite severe, she cannot communicate, wears nappies and self harms if her needs are not met immediately.

My problem is that when she needs her nappy changing she will not open her legs to let me or anyone clean her properly.

I have tried changing her standing up, sitting on the toilet seat and laying down, but she will not open her legs.

She is quite strong and I cannot use any form of force. I know that when she leaves me she will go onto a care home where they have more options, but as a foster career I simply do not know how to get around this.

At the moment I am laying her on a trolley and placing my elbow on one knee and my hand on the other, to keep her legs apart, which leaves my other hand free to clean her up. But she pushes my hand away.

Her parents simply shower her down (which is not really functional) her school do the best they can, but she always comes home sore because they have not cleaned her properly. If anyone has any ideas or suggestions please let me know.

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Try to figure out why she hates it and go from there
by: Anonymous

Have you tried making everyone use warm wipes? It is possible the cold ones feel very uncomfortable to her. And if possible always keep a barrier cream on her so she doesn't get more red and uncomfortable. Hopefully the cream will also prevent stool from crusting dry on her making it harder to clean off. I know it is one more step and if you can't even wipe her how do you cream her?
I would pay special attention to find out which part of the change bothers her the most. The act of opening her legs? Then practice doing this with her clothes on when no diaper will be changed. If she allows it with her clothes on but still not for changes it is either because she is hurting, it is cold and uncomfortable feeling, or do you think it is possible some one in the past or at school or anywhere could have ever been abusing her? Or has she been this way since birth?

Thank you for the ideas
by: Anonymous

I appreciate your comments. I had not thought of acting out the nappy change while fully clothed or of using warm wipes. As far as I know, this young lady has been like this since she first came into foster care. I have had her for just over 2 years (she used to be easier to handle, but she has become a lot stronger recently) I know very little of her previous foster carer. I cannot mention her birth parents, but nothing concerning abuse has ever been mentioned to me. I have however voiced some concerns to my social worker. Unfortunately because of the severity of her autism, we may never know. I will be trying your ideas out once she comes back from respite. I have a few days off because I found her laughing and hanging on some water pipes having climbed up on the windowsill to get to them yesterday. So I now have carpenter coming over to box in all pipe work no matter how high up they are. She certainly keeps me on my toes lol.

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